腰_5神经根孔外卡压症的诊断与手术治疗

Diagnosis and operative treatment of the L_5 nerve root compression in the extraforaminal area

目的 :分析腰 5 神经根孔外卡压症的病理解剖、诊断特点和手术治疗。方法 :对 2 4例腰 5 神经根孔外卡压症病人的临床手术资进行了回顾性研究。结果 :术后对其中的 18例病人进行了 0 .5年 -5年 ,平均 3.5年的随访观察 ,手术优良率达 94.5 %。结论 :孔外区腰 5 神经根卡压症的致病因素为孔外型椎间盘突出 ,椎间隙退变狭窄 ,腰骶椎滑脱 ,腰 5 椎体侧方骨质增生 ,腰 5 横突及骶骨翼肥大等。其诊断依赖于腰 5 根性卡压症、CT扫描或 MRI。手术减压是其有效的治疗方法 ,它包括经椎管入路、椎管旁入路或椎管内、外联合入路 。

Objectives:To analyze the pathoanatomy, diagnostic feature and surgical treatment of L 5 nerve root compression in the extraforaminal area.Methods: Twenty four patients undergoing extraforaminal decompression in L 5S 1 segments were reported.Result:18 patients were followed up from 0 5 years to 5 years (mean 3 5 years) postoperatively.The excellent and good results were 94 5%. Conclusions: The extraforaminal disc herniation,spondylolisthesis of the L 5 vertebra,enlargement of L 5 or S 1 transvers process,lateral marginal osteophytes of L 5 vertebral body all may constrict the extraforminal areas of L 5S 1 to cause entrapment of the L 5 nerve root.CT and MRI were the satisfactory methods for the diagnosis of the disorder. Decompression of the L 5 nerve root may performed by intraspinal or paraspinal approaches.The L 5 nerve root injury should be avioded during operation.